DESCRIPTION (provided by investigator): A large and growing population of patients survive acute critical illness only to become "chronically critically ill," with profound debilitation, prolonged hospitalization, and often permanent dependence on life-sustaining technology. Chronic critical illness is a serious health problem for the nation and especially for older adults, as the majority of these patients are over age 65. Despite technologically advanced treatment, mortality rates remain high and extreme functional dependence is typical for survivors. No previous research has focused on the symptom experience during treatment for chronic critical illness in any care setting, yet potential sources of suffering for chronically critically ill patients are many, and preliminary data suggest significant symptom distress. Nor has there been an investigation of the relationship between symptom burden and other important clinical or utilization outcomes of chronic critical illness, although symptom distress is known to predict adverse outcomes in other clinical settings. The proposed research will fill these gaps in existing knowledge. Our First Aim is to determine the prevalence and characteristics of distressing symptoms during chronic critical illness. The investigators will assess symptoms and related distress through patient self-reports in a prospective cohort study using a validated symptom assessment instrument that is practical and feasible for use with chronically critically ill patients. The Second Aim of this project is to evaluate the association of symptom distress with other important outcomes of chronic critical illness, including success in liberation from mechanical ventilation, time to ventilator independence, functional status, and survival. Using symptom information and data collected with respect to selected patient-related variables and medications, the investigators will perform statistical modeling to evaluate associations between symptom burden and other outcomes of interest. Rigorous study of the prevalence, intensity, and impact of symptom distress is a necessary precondition and strong impetus for quality improvement efforts. Data and analyses from the research we propose here will provide the evidentiary foundation for development of interventions specifically aimed at symptoms associated with distress and clinically important outcomes for older patients with chronic critical illness. We plan to evaluate such interventions in a future phase of research.